İbrahim KARAMAN, Ayşe KARAMAN, Yusuf Hakan ÇAVUŞOĞLU, Yasemin DERE GÜNAL, Mustafa Kemal ASLAN, Derya ERDOĞAN

Hirschsprung Hastalığında Transanal Endorektal Pull-through ve Martin-modifiye Duhamel Ameliyatlarının Sonuçlarının Karşılaştırılması

Amaç: Hirschsprung hastalığı (HH) tanısıyla transanal endorektal pull-through (TEPT) ve Martin-modifiye Duhamel ameliyatları yapılmış olanhastalarımızın sonuçlarının karşılaştırması.Gereç ve Yöntem: Kliniğimizde 2002-2007 yılları arasında HH nedeniyle TEPT (grup 1, n=24), transanal yolla başlanıp laparotomi gerektirenendorektal pull-through (grup 2, n=12) ve Martin modifiye Duhamel (grup 3, n=17) uygulanan 53 hasta değerlendirildi. Bu hasta grupları yaş,cinsiyet, aganglionik segment uzunluğu, intraoperatif detaylar, postoperatif erken dönem komplikasyonlar ve uzun dönem fonksiyonel sonuçlaraçısından değerlendirildi ve karşılaştırıldı.Bulgular: Çalışmamızda grup 1 hastaların ortalama ameliyat yaşı, ameliyat süresi, oral beslenmeye başlama zamanı, ilk gaita çıkarma zamanıve hastanede kalış süresi grup 2 ve grup 3 hastalarla karşılaştırıldığında anlamlı olarak az veya kısa bulundu (p0,05).Serimizde postoperatif enterokolit oranı grup 3’te yüzde olarak daha yüksek bulunmasına rağmen aralarındaki bu fark anlamlı bulunmadı (p>0,05).Her üç düzeltici tekniğin uzun dönem fonksiyonel sonuçları (kontinans, fekal soiling, kabızlık) değerlendirilip karşılaştırıldığında aralarında anlamlıbir fark bulunmadı (p>0,05).Sonuç: TEPT tekniği kolay uygulanabilen güvenli bir tekniktir. Özellikle erken dönemde tanı konmuş, enterokolit öyküsü olmayan, henüz bağırsakdilatasyonu gelişmemiş, rektosigmoid tutulumlu HH’lerde TEPT ilk tercih olabilir

Comparison of the Results of Transanal Endorectal Pull-through and Martin-modified Duhamel Operations in Hirschsprung Disease

Objectives: We compared the results of patients who underwent transanal endorectal pull-through (TEPT) and Martin-modified Duhamel operations for Hirschsprung’s disease (HD). Materials and Methods: Between 2002 and 2007, we evaluated 53 patients with HD treated with TEPT (group 1, n=24), endorectal pull-through with a laparotomy requirement after an initiated transanal approach (group 2, n=12) and Martin-modified Duhamel (group 3, n=17). Age, genderlength of aganglionic segment, intraoperative details, postoperative early complications and long term functional outcomes are evaluated and compared among these patient groups. Results: In this study age at the time of the operation, duration of the operation, time to first oral feeding, time to first stool and hospital stay in the patients the group 1 were significantly less or shorter than those ones in group 2 and group 3 (p0.05). Postoperative enterocolitis had a higher incidence in group 3, but there was also no significant difference (p>0.05). There was no difference in the long-term functional results (continence, fecal soiling, constipation) of all three procedures (p>0.05). Conclusion: TEPT is both a feasible and safe technique. It may be the first choice particularly in patients with early diagnosed rectosigmoid HD patients without enterocolitis or bowel dilatation.

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